Study of methacholine positivity in patients with chronic cough at Masih Daneshvari hospital, Tehran, 2007-2008

While airways reactivity is among the characteristics of asthma, is not considered a sufficient condition diagnostically and the methacholine challenge is a non-specific diagnostic aid in cases of chronic cough and reactive airways disease. The aim of this cross-sectional study was to determine the metacholine response positivity and diagnosis of asthma in patients with chronic cough presenting to a hospital in Tehran during 2007 and 2008. Of 101 patients with chronic cough [with no history of sinusitis, recent pulmonary infection, bronchitis, gasteroesophageal reflux or underlying pulmonary conditions], 51.5% showed reactive airways disease to the methacholine test, 40.6% were unreactive and 7.9% were indeterminate. A positive methacholine challenge test was positively correlated with new wheezing. Although the methacholine challenge test is not a primary test for evaluating chronic cough, if no other reason for chronic cough is found, it may be a guiding test for asthma

Status and costs of smoking cessation in countries of the Eastern Mediterranean Region

The aim of this cross-sectional observational study was to address the health care situation in regard to smoking cessation efforts and expenditure, and to provide a basis for future studies and for implementing tobacco control programmes throughout the Eastern Mediterranean Region of the World Health Organization. Information collected included methods and cost of services for tobacco cessation from all 16 participating countries. In 10 countries, cessation programmes were directed by primary physicians. In 13 countries, nicotine gum and in 14 countries nicotine patches were accessible in pharmacies. Bupropion was available at pharmacies [with a written prescription] in 6 countries and varenicline in 7 countries. However, the mean cost of each service was significantly higher than the price of a pack of cigarettes. In countries with support services for tobacco cessation, directors need to provide care at the society level that is considerably less costly and widely accessible

Drug resistance pattern and outcome of treatment in recurrent episodes of tuberculosis

Patterns of drug resistance in recurrent cases of tuberculosis may be different than in those without a history of treatment. In this retrospective study, the drug resistance pattern and outcome of treatment with DOTS category I [CAT I] regimen was compared in 63 recurrent cases and 872 new cases of pulmonary tuberculosis from April 2003 to January 2008 at the National Research Institute of Tuberculosis and Lung Disease in Tehran, Islamic Republic of Iran. Resistance to isoniazid and ethambutol was significantly more common in recurrent cases, but there were no differences in rates of resistance to rifampin, pyrazinamide, streptomycin or the rate of multi-drug resistant strains. Resistance to streptomycin was the most common. No significant differences in treatment outcome and deaths were found between the 2 groups. Due to the low frequency of multi-drug resistance in the recurrent cases, a CAT I regimen may be suitable for empirical therapy before drug sensitivity results become available

Comparison of tobacco control policies in the Eastern Mediterranean countries based on tobacco control scale scores

This cross-sectional survey aimed to provide an overview of tobacco control strategies in the countries of the Eastern Mediterranean Region [EMR]. A questionnaire to collate data on implementation of 6 major policies was developed based on the previously published Tobacco Control Scale and using MPOWER measures of the WHO Tobacco Free Initiative and the Tobacco Atlas. Only 3 of the 21 countries scored higher than 50 out of 100: Islamic Republic of Iran [61], Jordan [55] and Egypt [51]. More than half of countries scored less than 26. Highest scores were achieved by Afghanistan in cigarette pricing, Oman in smoking bans in public places, Islamic Republic of Iran in budgeting, prohibition of advertisements and health warnings against smoking and Syrian Arab Republic, Tunisia and Kuwait in tobacco cessation programmes. The low mean total score in EMR countries [29.7] compared with European countries [47.2] highlights the need for better future planning and policy-making for tobacco control in the Region

Common methods to treat addiction in treatment- rehabilitation centers in Tehran

This study was to determine common methods to treat addiction used by patients checked into Outpatient Treatment and Rehabilitation Clinics in Tehran. The study was conducted in Social Security affiliated outpatient clinics including three governmental and several private centers in 22 districts of Tehran. Demographic data, personal information, social characteristics and information regarding prevention, treatment, and follow-up records of 1,372 patients were obtained and analyzed. A majority of cases referring to the treatment centers were male [95.2%]. Patients were 14 to 75 yr [mean 35.48 +/- 10.57 yr]; 61.7% were married and lived in rented homes in the city; 938/1372 [68.4%] had at least one previous attempt failure when seeking re-treatment. A majority of them [77.8%] had a history of 1 to 4 quit attempts; a number 63.1% had an abstinence period of 1 week to 6 months. The majority of our understudy subjects had a history of previous attempts to treat their addiction with a maximum abstinence period of 6 months

[Identifying Mycobacterium tuberculosis resistance to rifampin by multiplex specific PCR method]

Mycobacterium tuberculosis is still considered the most common cause of death cases related to pathogenic infectious factors in the world. Rifampin is among the most important first-line drugs to treat tuberculosis. The most common mutations in resistance to Rifampin occur due to the displacements in Codons 531, 526, and 516 in rpoB gene. This study was carried out with the aim of introducing the method [Multiplex Allele Specific] PCR in order to identify tuberculosis patients resistant to rifampin through detecting mutations in the rpoB gene. In this study, three cases of mutation were evaluated in three Codons of rpoB gene in 90 samples of the positive cases of culture from pulmonary TB patients who had referred to Research Center of Mycobacteriology located in Masih-Daneshvari Hospital of Tehran from 1385 to 1387 after the drug sensitivity test. To examine three codons 531, 526 and 516, MAS PCR method was used. The results of the culture showed that 33.3% of the samples were sensitive and 66.6% were resistant to drugs of which 44.4% were resistant to Rifampin. By using MAS PCR method, 32.2% of these cases of resistance were identified. Among these cases, 43.4% had mutation in codon rpoB 531, 34.5% in rpoB 526 codon and 31% in rpoB 516 codon. Based on the results of this study, MAS PCR method used in this research is an accurate and appropriate method to rapidly diagnose resistance to Rifampin in the clinical samples of Mycobacterium tuberculosis

[Is smoke free legislation enforcing completely in Tehran 2009?]

Creating smoke-free public places is essential to protect non-smokers and it also motivates smokers to quit. Considering the smoking ban law in public places of Iran and weakly enforcement of this law, we decided to study the circumstances in Tehran. It was a cross-sectional study which has been done during 2009. Firstly, Tehran's geographic map was divided into 3 areas of north, center and south and secondly 10 spots in each area were selected randomly. By reaching to that addresses easy sampling was done and going straightly toward the right side to collect enough cases. The indicators including 'the existence of smoking ban signs, ashtrays and smoking areas and also the way of showing objecting against smoking' were questioned and observed. 458 restaurants and food courts were studied. In 60 places [13%] there were no smoking ban signs. In 140 places [30%] there were ash trays and in 54 places [12%] there were smoking areas. In 132 places [29%] the in-charge people had no objection against smoking in restaurants. All the cases were aware of smoking ban law in public places. More than 50% considered it as a useful law and 106 restaurants [23%] believed that the law enforcement would increase the number of customers. There was no statistically relationship between the place and working year of restaurants and law enforcement but it was shown a statistically relationship between smoking ban signs and showing objection against smoking and increasing the number of customers [p=0.000]. In spite of the fact that it has been a long time sine the law adaptation, but it has not been fully implemented, so it is necessary to reinforce the law

[Relationship between TNF-alpha gene polymorphisms and susceptibility to pulmonary tuberculosis]

Tuberculosis [TB] caused by Mycobacterium tuberculosis, is an infectious disease in human which kills nearly three millions of people annually. Approximately, one - third of the world populations are infected with this bacteria and 5 - 10% of them develop the active form of the disease. Individuals are different in susceptibility to TB infection. These differences might be due to the host characteristics especially genetic factors. TNF- alpha as a pro-inflammatory cytokine, plays a key role in host defense against tuberculosis. Presence of mutation in this gene can influence the effectiveness, performance and capability of immune responses against TB infection. The Aim of this study was to investigate the frequency of TNF- alpha gene polymorphisms and its relation with susceptibility to the pulmonary TB. Sixty healthy controls and 60 TB patients were enrolled. Genotype of TNF[-238], TNF -244, TNF[-308], TNF[-857] and TNF[-863] were determined using PCR-RFLP method. The results were analyzed by Fisher Exact and kappa[2] tests using SPSS v.14 and evaluated with Hardy-Weinberg equilibrium. The results of this study showed a significant difference in TNF-308 and TNF [-857] regions between the control and study groups [P < 0.05]. Presence of mutation in TNF[-308] and TNF [-857] regions may increase the host susceptibility to mycobacterium tuberculosis and genotyping of these regions can be used for screening of the high risk individuals

[ rapid identification of atypical mycobacterium in pulmonary tuberculosis [PTB] patients: evaluation of QUB3232 locus using the VNTR method]

Identification of atypical mycobacterium [Non tuberculosis Mycobacterium; NTM] is important because of the worldwide propagation of these organisms. Recently, molecular studies have identified the specific loci for mycobacterium species by DNA - finger printing methods, but these methods are time-consuming and expensive. In this study, in addition to hsp65 PCR-RFLP method, QUB3232 locus was evaluated for differentiation of atypical mycobacterium from mycobacterium tuberculosis complex. This study was performed on 371 pulmonary and non pulmonary specimens separated from patients with the symptoms of pulmonary tuberculosis [PTB]. After the isolation and culturing of mycobacterium strains using the Lowenstein Jensen media, biochemical tests including production of Niacin, Catalase activity, Nitrate reduction, pigment production and growth rate were performed. Drug susceptibility testing was performed by proportional method. DNA extraction was performed by phenol-chloroform method. hsp65 gene was amplified by PCR. Subsequently the amplicons were digested with three restriction enzymes namely AvaII, HphI and HpaII and electrophoresed on 3% agarose gel. QUB3232 locus was also evaluated for differentiation of atypical mycobacterium and mycobacterium tuberculosis complex. Out of 371 isolates, 32 [8.6%] were multi-drug resistant TB [MDR-TB], 184 [49.5%] were susceptible and 155 [42.5%] were non MDR [combined resistance] that 15% of MDR cases and 25% of non MDR cases were non tuberculosis mycobacterium. Out of 31 slow growing isolates, 58% were M. simiae and 19% were M. kansasii. The sensitivity of QUB3232 locus for differentiation of the atypical mycobacterium from mycobacterium tuberculosis complex was 80%. From the total of 43 NTM samples, 12 [27.9%] were rapid growing and 72% were slow growing. QUB3232 locus has the high discriminative power for differentiation of atypical mycobacterium from the mycobacterium tuberculosis complex, therefore, it can be used as a substitute for PCR-RFLP method

[Mycobacterium tuberculosis complex strains identification with spoligotyping method in patients attending to Masih Daneshvari Hospital]

Spoligotyping is a method based on 36bp Direct Repeat [DR] chromosomal loci polymorphism which is connected to one or two 35-41 bp spacer sequences. There are 94 different intra DR spacer sequences which are identified so far and only 43 of them are used as usual. Mycobacterium tuberculosis complex strains can be identified based on lacking or having these sequences. Spoligotyping test was carried out on 238 TB smear positive patients. Primary separation of mycobacterium strains was done through Petrof 4% method and Lowenstein Jensen [LJ] media. Biochemical tests such as Niacin test/Catalase activity/Nitrate reduction were done in order to identify the strains. Drug sensitivity to INH [0.2Mg/ml]/ RIF [40Mg/ml]/ STM [10Mg/ml] and ETBl [2Mg/ml] identified by proportional method and according to that, the strains were divided into three groups: sensitive, multi drug resistance [MDR] and non MDR. Then DNA was extracted by CTAB method from the positive colonies. Sequences were amplified by PCR and after denaturizing, hybridization with Streptavidine peroxidase enzyme was performed by Line reverse blot method. Radiography was done after adding the Luminoscense and membrane onto the X-ray films. Serotypes were divided into 9 groups [Beijing/ CAS1/ Haarlem / U/ T2/ T1/ EAI3/ EAI2 and CAS2]. Most of the strains were from Haarlem [27%] and CAS1 [25%] groups. Two strains were also identified in this method that belonged to Mycobacterium bovis. Spoligotyping method is an easy, rapid and sensitive test in order to identify Mycobacterium tuberculosis complex strains

Comparison of the effectiveness of 2 treatment regimens in patients with isoniazid-resistant tuberculosis

We compared the effectiveness of 2 treatment regimens for isoniazid-resistant tuberculosis [TB] in 42 patients attending a TB referral centre in the Islamic Republic of Iran. The patients were divided into 2 treatment groups: 26 received the 6-month standard HRZE treatment and 16 received a modified treatment of RZE for 6 months. There were no significant differences in age or sex of the groups. With the standard method of treatment, 21 [80.8%] patients were cured, 4 [15.4%] resulted in treatment failure, and 1 [3.8%] died. In the modified treatment group, 16 [100%] patients were cured. These differences were not statistically significantly different [P = 0.194]

Clinical and laboratory profile of patients with tuberculosis/HIV coinfection at a national referral centre: a case series

This case series describes the clinical and laboratory profile of 15 patients with tuberculosis [TB] HIV coinfection admitted to a referral centre in the Islamic Republic of Iran. Most of the patients [13] were male; the mean age was 36.9 years. Intravenous drug use was the route of transmission for all males and heterosexual intercourse for the 2 females; 12 patients had a history of imprisonment. All patients had pulmonary TB; 13 were smear-positive and all except 1 had atypical radiological presentation. Drug-induced hepatitis occurred in 3 patients and 12 had hepatitis C coinfection. Five patients died. The mean CD4 count was 229.2 [SD 199.5] cells/mm[3] and 78.6% had CD4 count < 350. TB may be an AIDS-defining illness in this country

Role of private laboratories in tuberculosis detection in Tehran, Islamic Republic of Iran

To study the participation of the private sector in detection and diagnosis of tuberculosis, all suspected cases referring to 4 private laboratories in Tehran for acid-fast bacillus examination during 2002-03 were documented. Of 9037 cases enrolled in the study, 637 had positive examination results [7.1%]. Of these 531 [5.9%] cases were direct smear-positive and 489 [5.4%] were culture-positive. Data from the Iranian Ministry of Health showed 9479 cases referred to government laboratories in Tehran urban area during the study period, 208 [2.2%] of which were positive. This larger than expected proportion of TB patients who are detected and managed by the private sector indicates that much closer cooperation is needed between the public and private sectors

Prevalence and severity of allergic rhinitis among children of Tehran and Rasht: ISAAC study Phase III

Atopic disorders, for example atopic rhinitis, have had an incremental global trend. Epidemiological studies performed around the world have shown conflicting results; therefore, finding the accurate frequency of this disorder requires running a uniform and standard study. The aim of this study, as a part of International Study of Asthma and Allergy in Childhood [ISAAC], was to define and compare the prevalence of allergic rhinitis among 6-7 and 13-14 year old children of Tehran and Rasht during the years 2001-2002. This cross sectional-analytical study was performed during the years 2001-2002 in 63 elementary and 22 middle schools of Rasht and 51 elementary and 21 middle schools of Tehran, which were selected by cluster randomization of all schools in both cities. A total of 6145 children of Rasht and 6845 children of Tehran were enrolled into our study among which 54% were male and 48% were female in Rasht and Tehran, respectively. 3065 [50.5%] of Rasht students and 3015 [49.1%] of Tehran students were 6-7 years old and the remaining were 13-14 years old. The prevalence of rhinitis along with conjunctivitis was 4-5 times higher during a one year period among Tehran students. History of allergic rhinitis showed no significant difference between students of the two cities and was more prevalent among older children. Amongst the entire students, allergic rhinitis and rhino-conjunctivitis were more prevalent during January and February in Tehran, and April and May in Rasht. Prevalence of recent allergic rhinitis and rhino-conjunctivitis has been higher among Tehran students compared to students of Rasht, which demands for further and more precise evaluation

[Incidence rate of pulmonary tuberculosis among different ethnicities in Golestan province from 1999 to 2003]

Over the last few years, the province of Golestan has ranked second among all Iranian provinces in terms of TB prevalence after Sistan and Balochestan. The present study was done with the aim of evaluating the incidence of TB among different ethnic groups residing in Golestan. In a descriptive study, all TB patients including sputum smear-positive and negative, extra-pulmonary, and milliary cases were evaluated from 1999 to 2003. The incidence of all types of TB was compared among different ethnicities in the province. Forty-seven percent of the 2773 cases registered for Golestan Province in the Communicable Disease Control Center from1999 to 2003 were male. As regards the type of disease, 62.7% of the cases were sputum smear-positive, 16.4% were smear-negative, 20.7% had extra-pulmonary disease, and 0.1% was milliary TB cases. The incidence rate of all types of TB was 36 per 100000 populations and the rate did not show any significant changes over the study period. As for the ethnic distribution of the cases, more than 50% of all TB cases were observed among Sistanis and Baluches, who together account for only 20% of all Golestan residents. The incidence in Sistanis was ten times that in Turks and Kurds, six times that in Persians, 4 times the rate in Torkamans, and 2.5 times that in Afghans living in the same region. The incidence rate of tuberculosis was significantly different among various ethnicities of Golestan province, being highest in Sistanis

Tuberculosis of the breast: report of 4 clinical cases and literature review

Nearly 18% of tuberculosis [TB] cases have only extrapulmonary manifestations. Breast tuberculosis is a rare type of extrapulmonary TB. This paper reports 4 cases of breast TB confirmed either pathologically or mycobacteriologically or both. These reports showed that TB should always be considered first in the differential diagnosis of granulomatous mastitis in TB-endemic areas. Therapy included at least 6 months of anti-TB medication and surgery when indicated

Prevalence of smoking among high-school students of Tehran in 2003

This study in 2003 determined the prevalence of smoking and its associated factors among high-school students in Tehran, Islamic Republic of Iran. Out of 1095 students aged 14-18 years, 29% [31% boys, 26% girls] were occasional and 5% [6% boys and 2% girls] daily smokers. Among occasional smokers, 21% had family members who also smoked, whereas for students who had never tried smoking, no family members smoked. Of 316 occasional smokers, 12% lived with a single parent compared with only 5% of never smokers. Regression analysis showed that significant risk factors for daily smoking were: having a brother or sister who smokes [OR = 8.58] and having more than 1 family member who smokes [OR = 6.33]

[Registration status of patients with tuberculosis detected by private laboratories, Tehran/Iran]

To determine the registration status of patients with tuberculosis [TB] detected by private laboratories. a cross sectional study Out of all TB suspected subjects referred to four private labs for acid-fast bacilli [AFB] examination during 2002-3, those with confirmed TB were enrolled in this study. All AFB positive cases were then followed for registration by National Tuberculosis Program [NTP] of the Ministry of Health of Iran. Of all the cases referred to the private laboratories, 646 subjects were reported as AFB positive and followed. Of these, 317 [49.1%] were female and 328 [50.8%] male, with a mean age of 52.2 years [95% CI, 21.7]. Using telephone and dwelling addresses to contact patients, 82 [12.7%] patients were found to be registered by NTP and 564 [87.3%] were not registered. Registration status was independent of age and sex [p=0.122, p=0.178]. However, a positive association was detected between physician referral of patients and registration [Fisher's exact test, p<0.00 1]. The cases detected and treated by private sector are far beyond our expectation, which indicates the valuable role of this sector in tuberculosis detection. Nevertheless, what needs to be improved is the management of relations between private and public sectors. On the other hand, physicians play an essential role in referring patients to NTP for registration, but it seems that they have not been performing well enough given the small proportion of patients referred